Signature:
Date:_
We hereby RELEASE, WAIVE, DISCHARGE AND COVENANT NOT TO SUE Middle Tennessee State University, the Board
Regents of the State of Tennessee, their officers, or employees (hereinafter referred to as RELEASEES) from any and
liability, claims, demands, actions and damage or injury, including death, that may be sustained by me, or which may
from emergency medical treatment sought as a result of said participation in the activity. We further hereby AGREE
INDEMNIFY AND HOLD HARMLESS the RELEASEES from any loss, liability, damage or cost, including medical bills,
costs and attorney’s fees, that may occur due to participation in said activity, WHETHER CUASE BY NEGLIGENCE
RELEASEES or otherwise. We subjectively understand the risks of participation in this activity. Knowing and
these risks, I, the aforementioned participant’s parent/guardian, further state that I am fully competent to sign
agreement. We expressly intend for myself, for the participant, and for participant’s family, estate, heirs,
personal representative, or assigns to be bound by this document, and it shall be deemed as a RELEASE, WAIVER,
DISCHARGE AND COVENANT NOT TO SUE the
RELEASEES. This document shall remain in effect for each
every time participant participates in the activities listed herein. This release shall be construed in accordance with the
I give authorization for the Confucius Institute to use my child’s photograph in any future web or print
advertisements. I understand my child’s full name will not be used.
Parking
Parking permits are required on campus at
all times. Please bring license plate number
to camp registration, and you will be issued
a parking permit and shown where you are
allowed to park.
Lunch
Campers will need to bring their own lunch.
IMPORTANT: Children must have received
all school- required shots.
CIMTSU Camp is not responsible for
personal items that are stolen, lost, or
misplaced.
For more information, please contact
Hellen Zhou, jie.zhou@mtsu.edu
615-638-7079
Rachel Qian, qianrui1220@yahoo.com
615-713-6243
China
Exploration
Language
Games Art
Culture
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What To Bring / Wear
Participants should come dressed in
comfortable clothing appropriate for
playing games and other activities. Tennis
shoes or other closed-toe shoes should also
be worn.
Chinese Language and Culture
Summer Camp
Monday to Friday, 6/1 – 6/5/2015
9:00AM – 4:30PM
Peck Hall 106
Date: Monday to Friday, June 2 – 7, 2014
Time: Drop off: 8:00AM
Courses and activities start at 9:00Am
Pick-up: 4:30PM
Please make check payable to CIMTSU and
send it along with the registration form to:
MTSU Box 114, Peck Hall 106,
Murfreesboro, TN 37132
Phone: 615-494-8696
Please include FULL PAYMENT. A separate application is required for each child/camp
registration. Please make check payable to CIMTSU and send it along with the registration form to:
MTSU Box 114, Peck Hall 106, Murfreesboro, TN 37132 Phone: 615 494 8696
By submitting this form you agree the terms stated on the other side of this form. Please sign it.
registration must accompany each registration
form. Drop-in: $30 per day plus $25 one time
registration fee.
Registration Form may also be obtained at
www.mtsu.edu/cimtsu
Health/Allergy Concerns: _____________________________________
Cost: $120. A $25 nonrefundable deposit for
Age:____ M___ F___
NOTE: A program cancellation fee of $25.00
will be charged for all cancelled camps. There
will be NO REFUNDS if a student withdraws
from any of our summer programs after three
days of participation.
Tuition & Registration
Parent’s Email____________________________________________________________________
*Refund Policy:
Confucius Institute reserves the right to change
or cancel any program. Efforts will be made to
assign the students affected by such a change
or cancellation to other available programs. A
complete refund will be given in those cases
where other program placement is not
possible.
Summer Chinese Camp will provide a
great opportunity for children to learn Chinese
language and culture. The program includes
formal language lessons and colorful activities.
Campers will learn basic vocabulary and
conversation, and experience Chinese culture
through games, crafts, calligraphy, and art.
The goal is to help each participant:
- To enrich culture experience
- To learn the basics of Chinese language
- To be motivated to explore
Address: _______________________________________________________________________
Attendants will allow you to proceed to the
checkout procedure. You can also sign out
your camper to the counselor. Campers are
only allowed to leave with people who are
on the Pick-Up Authorization list.
The
Student’s Name______________________________________________________
(First Floor at the Southeast Quarter)
Parent’s Name_________________________________ Cellphone __________________________
Location: MTSU Peck Hall 106